Background:Coronavirus 2019 (COVID-19) has had a great effect on the health care landscape, including altering the availability and methods of orthopaedic care. There is little information regarding patients' perceptions of orthopaedic care during the pandemic. This study was designed to assess patient concerns surrounding orthopaedic care and determine what areas can be addressed to optimize orthopaedic care during this pandemic. Methods:In the spring of 2020, during this study that was exempt from institutional review board (IRB) approval, a survey designed to evaluate the attitudes and beliefs from healthcare consumers about receiving care during the COVID-19 pandemic was sent to a group of panelists via email. Results:Three hundred sixty-six (31%) out of 1,200 individuals completed the survey. The majority of participants expressed they would feel comfortable receiving care in orthopaedic clinics (48% immediately, 36% in 1 to 3 mo) in the immediate or near future. Participants reported they were more comfortable seeking orthopaedic care at an orthopedic urgent care facility (8% not comfortable) versus an emergency room (41% not comfortable). When thinking about receiving care at orthopaedic clinics, participants were most concerned about the risks of getting sick from other patients (18% extremely, 26% very). Seventeen percent of respondents reported that despite having orthopaedic concerns, they delayed seeking care due to COVID-19. One-third of respondents expressed a desire to know what precautions were in place to ensure safety. Conclusions:Patients remained interested in receiving orthopaedic care in the midst of a pandemic. As a result, physicians need to ensure that they effectively communicate what safety precautions are in place and what additional infection prevention measures are available.
Objective: To determine the total cost for a 30-day episode of care for high-energy tibial plateau fractures and the aspects of care associated with total cost.Design: Time-driven activity-based costing analysis.Setting: One Level 1 adult trauma center. Patients:One hundred twenty-one patients with isolated, bicondylar tibial plateau fractures undergoing staged treatment were reviewed.Primary Outcome: Total cost.Results: A total of 85 patients were included and most sustained Schatzker VI fractures (n = 66, 77%). All patients were treated with biplanar external fixation before definitive fixation. A total of 26 patients (31%) were discharged to skilled nursing facilities, and 37 patients (43%) were not discharged between procedures. Total cost for a 30day episode of care was $22,113 6 4056. External fixation components ($5952, 26.9%), length of hospital stay ($5606, 25.4%), discharge to skilled nursing facility (SNF) ($3061, 13.8%), and definitive fixation implants ($2968, 13.4%) contributed to the total cost. The following were associated with total cost: patient discharged to SNFs (P , 0.001), patient remaining inpatient after external fixation (P , 0.001), days of admission for open reduction internal fixation (ORIF) (P = 0.005), days spent with external fixation (P , 0.001), days in a SNF after ORIF (P , 0.001), and external fixation component cost (P , 0.001). Conclusions:External fixation component selection is the largest contributor to cost of a 30-day episode of care for high-energy bicondylar tibial plateau fractures. Reduction in cost variability may be possible through thoughtful use of external fixation components and care pathways.
4391 Prothrombin complex concentrates (PCCs) are used in the management of bleeding complications with conventional oral anticoagulant drugs such as warfarin. These concentrates are also used in supportive therapy for hemostatic disorders. More recently these agents have been investigated for neutralization of the newer oral anticoagulant drugs such as the direct factor Xa and thrombin inhibitors. Since the activation of these complexes results in the generation of factor Xa and IIa, these agents may potentially neutralize both Xa and thrombin inhibitors. However, the potency of these agents is defined in units which represent the level of factor IX, other factors including factor II, VII, and X are also present, and in unspecified amounts. Moreover, other vitamin K-dependent proteins such as protein C, protein S, and protein Z may also be present. Varying amounts of albumin and other agent such as heparin and antithrombin may also be present as an additive. The purpose of this study is to compare the compositions of the currently available PCCs such as Profilnine®, Beriplex®, Cofact®, Octaplex®, Prothromplex®, and the older agents such as Konyne®, Preconetiv®, and Feiba®. Materials and Methods: Commercially available PCCs were obtained from various suppliers. Each of the individual vials of these concentrates was diluted with saline to obtain a 10 U/ml factor IX solution. Protein content was measured using Lowry's method. Sodium dodecyl sulfate polyacrylamide gel (SDS-PAGE) electrophoresis was carried out by dilution of each concentrates to 2 U/ml. Western blot analysis was performed to determine presence of prothrombin, prothrombin-1, and thrombin using anti-human recombinant thrombin antibody capable recognizing these proteins. Tissue factor activation profiles of each PCCs was also studied using Innovin®. The protein composition of native and activated prothrombin complexes was also investigated using surface-enhanced laser desorption/ionization (SELDI) mass spectrometry utilizing the gold chip array (BioRad). Tissue factor mediated thrombin generation by each of the prothrombin complex was studied using a fluorometric method (Technoclone, Vienna, Austria). Results: The total protein content of these PCCs ranged from 18–106 mg/100U. Some of the products were found to contain varying amounts of albumin, antithrombin and heparin as evident in both SDS-PAGE and SELDI analysis. The SDS-PAGE profile of these complexes showed multiple protein bands ranging from 15 to 250 kDa. Beriplex and Profilnine showed fewer bands; Profilnine® mainly exhibited 250, 110, 75 kDa bands and Beriplex® mainly 75 and 66 kDa bands. The other products contain additional bands in the range of 15 to 66 kDa representing albumin and other products. In the SELDI analysis multiple peaks consistent with the SDS-PAGE profile were noted. The immunoblotting showed a major band 70–75 kDa (prothrombin) along with a 50 kDa band representing prethrombin-1. Prior to activation, Feiba® exhibited a distinct additional 37 kDa dense band, (thrombin). SELDI analysis also indicated variable amounts of prothrombin in the products. Upon activation all PCC's were capable of generating thrombin as measured by SELDI and immunoblotting. The prothrombin band completely disappears from all PCCs except Preconetiv®, the prevalent products being prethombin-1 and thrombin. The amount of the prethrombin-1 band varied widely among products; and nearly disappears from all as it is converted to thrombin with time of incubation. The amount of thrombin activity generated from each prothrombin complex was concentration dependent and ranged from 30–1044nm/1.25 units/ml. Octaplex and Cofact produced the strongest thrombin activity whereas Beriplex and Prothromplex produced the least thrombin activity. Conclusions: This study shows that despite standardization in factor IX units, at equivalent IX unit potency these agents widely vary in their composition. Beriplex® and Profilnine® represent purer preparations. Upon activation of prothrombin initiated by tissue factor each complex is capable of generating varying amounts of thrombin. Because of these wide variations in protease generation the relative neutralization potential of each of these PCCs may also differ widely. Thus each of these products should thus be considered as a distinct agent and their efficacies individually determined for a given indication. Disclosures: No relevant conflicts of interest to declare.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.